By checking this box, I agree to the statements below.
PERMISSION SLIP FOR ACTIVITIES AT LIGHTHOUSE BAPTIST CHURCH LEBANON, IN
Medical and Liability Release/Permission Slip
I agree to participate in the activities with the Lighthouse Baptist Church. This Activity may include: sporting events, farm activities, camping trip, roller coasters, hiking, paintball activities, eating and the like. I fully understand that the Activities could involve certain significant risks or dangers to me or my child, and I willingly assume full responsibility for any consequences, including bodily injury or death, which may result to me and/or my child from participation in this activity.
I also understand that the primary reason for the activity is to religiously educate and to reach with the Gospel of Jesus Christ those who participate.
In consideration for being permitted to participate in the activities, I do hereby, on behalf of myself and/or my aforementioned child:
1) Authorize Lighthouse Baptist Church of Lebanon, Indiana, in an emergency, to obtain medical treatment for me and/or my child in the event that I am unable for a reason to make provision for such treatment, and;
2) Release and hold harmless the Lighthouse Baptist Church of Lebanon, Indiana their respective agents, employees, office directors, pastors, and staff members, from and against any and all liability, damages and claims of any kind, known or unknown which may result from or arise out of participation by me and or my child in the activity. This liability and lease includes but is not limited to accidental injury or death occurring out of transportation, food, entertainment, and medical conditions or treatments of any kind, and further includes accidental injury or death arising out of negligence by or on the part of the Lighthouse Baptist Church of Lebanon, Indiana.
I acknowledge reading and understanding this liability release prior to signing it. My signature is binding both me and my child as well as anyone else, such as relatives or others, who could otherwise seek recovery because of such injury
of death (i.e., all successors, heirs, next of kin, executors, martial communities, assigns, and personal representatives.)
Each participant agrees that it is not necessary for Lighthouse Baptist Church of Lebanon, Indiana or anyone else to contact them prior to releasing any information authorized by this document. Each participant hereby releases Lighthouse Baptist Church from any liability damages, or claims of any kind resulting from, distribution or disclosure of any photographs, films, videotapes, electronic recording or other information regarding participants and the activity.